Welcome to our office!

Patient Form

Your first visit to Clemmons Comprehensive Dental Care establishes a vital foundation for our relationship with you. During the first visit, we make sure to obtain important background information, like your medical history, and give you time to get to know your doctor. To understand what to expect for your first visit to our practice, please read through this page. You'll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies and more. There's also background information about our committed staff and our first visit procedures. You can even save some time at your first visit by printing out and completing the patient forms in advance of your appointment. Mission Statement Our practice is working together to realize a shared vision of uncompromising excellence in dentistry.

To fulfill this mission, we are committed to:

• Listening to those we are privileged to serve.
• Earn the trust and respect of patients, profession and community.
• Exceed your expectations.
• Ensure a creative, challenging and compassionate professional environment.
• Strive for continuous improvement at all levels.

Patient Forms Please print and fill out these forms so we can expedite your first visit:

Health History Form


Smile Assessment Form


General Consent Form


Acknowledgement of Privacy Practices

Privacy Practices (these are for your records, and do not need to be brought to your appointment):

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If you would like to be seen at Clemmons Comprehensive Dental Care, but cannot make your appointment during regular business hours, please let us know. We would be happy to work around your schedule, so that you can be seen on a day and time that is convenient for you. Although our regular business hours are currently limited, we do plan on adding more days and time slots to our schedule as our business grows.

Appointments

We know you have many choices when choosing a Dentist in Clemmons, NC so we have made requesting an appointment a simple process via our Web site. If, for any reason you cannot keep a scheduled appointment, or will be delayed, please call us as soon as possible. We do require a 24-48 hour notice for canceled or rescheduled appointments, depending on the procedure, to avoid a broken appointment penalty. If a last minute unforeseen event occurs that makes it impossible to make your appointment, please let us know as soon as possible.

What To Expect

Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It also will help relieve any unnecessary anxiety you may be feeling. Educate yourself on your symptoms by reviewing the content on this Web site. Also, take some time to review our staff page and familiarize yourself with the doctor and staff. We look forward to meeting you!

What to Bring: Please print and fill out the patient forms above. If you cannot print these forms out, please call our office and we would be happy to mail the forms to you ahead of time. Alternatively you could stop by our office to pick them up. Once completed, the forms can be mailed back to us, faxed to us at 336-293-6623, or scanned and emailed to us at contactus@dentistclemmons.com.

Dental insurance verification can be a lengthy process. This too can and should be done before your initial visit. Please mail, email or fax a copy of the front and back of your insurance card, and we would be happy to verify your benefits ahead of time. Alternatively you could call our patient care coordinator, Guadalupe at 336-293-6623 and give her your insurance information over the phone.

Please bring a picture ID, such as a driver's license with you to your initial appointment.

Insurance and Billing

We file most dental benefit plans. Prior to being seen we will attempt to run a dental benefits check with your dental plan provider. Although we try to get the most accurate information from your dental plan provider, these are only considered estimates, and patients are ultimately responsible for any portion of a bill in which a dental plan does not cover. It is therefore important for patients to understand the terms and conditions of their dental benefit plans, and to contact your dental benefit provider for specific information on what your plan covers, as well as annual limits and co-pays. We will submit all necessary paperwork, radiographs, and treatment notes to ensure that you receive the maximum benefit that you are entitled to from your dental plan provider. If you receive a notice from your insurer stating that more information is needed from us to process a claim, please let us know as soon as possible so that we can get these items submitted for you. Clemmons Comprehensive Dental Care does not participate in Health Management Organizations, nor do we accept Medicaid; however, we will be happy to file any other of your insurance claims for you. We accept checks, cash, credit cards, and offer financing through Care Credit. Please speak to our patient care coordinator for details. We are happy to file insurance for your reimbursement as long as your dental insurance or dental benefit provider allows us to do so. Again, any charges not covered by dental insurance or dental benefit plans are the responsibility of the patient.

Payment Options

We accept checks, cash or credit cards. We also offer a flexible payment plan through Care Credit. Please speak to our patient care coordinator for details. We are happy to file insurance for your reimbursement as long as your dental insurance or dental benefit provider allows us to do so.

Financing Options

CareCredit is here to help you pay for treatments and procedures your insurance doesn’t cover. We offer No Interest* financing or low minimum monthly payment options so you can get what you want, when you want it.